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Psychiatric evaluations crucial in political asylum decisions

Jul. 11, 2019, 9:20 AM

Jeffrey Stovall, MD, conducts forensic psychiatric evaluations of people seeking political asylum.
Jeffrey Stovall, MD, conducts forensic psychiatric evaluations of people seeking political asylum. (photo by Anne Rayner)

by Kelsey Herbers

Tens of thousands of people arrive at the United States border each year seeking refuge from violence, torture and trafficking, but they often have nothing more than their own words to substantiate their claims for political asylum.

One by one, they enter the complex legal process to determine if their story demonstrates a credible threat to their safety. Many of them arrive to their hearings exhausted and hopeless, which can interfere with their ability to paint a full picture of what life was like in the country they’re trying to escape.

Without enough evidence to support their stories of gang violence, discrimination or abuse, they’re often deported back into the same risky environment they tried to leave behind.

It’s stories like these that motivate Jeffrey Stovall, MD, associate professor of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center, to use his training as a physician to create lasting change.

“I see something happening in the world that I feel very hopeless to have any influence on, and it’s heartbreaking,” said Stovall. “Being a physician, I’m left wondering what I can be doing. We always feel like we can go in and fix something or help someone.”

For more than 20 years, Stovall has conducted forensic psychiatric evaluations of individuals seeking asylum to provide medical evidence of emotional injury, post-traumatic stress disorder, depression and other conditions that may interfere with a person’s ability to testify on their own behalf.

Some of Stovall’s clients are found in their initial hearing to not have a “credible fear” for returning to their home country and are appealing that ruling due to underlying barriers to their participation. Others may receive evaluations at various points in their legal journey.

The evaluations often take several hours to complete and are more extensive than traditional psychiatric evaluations performed in clinical settings. Since his clients speak their native language, which is typically not English, interpretation by phone or in person is necessary.

If Stovall finds evidence of an underlying mental illness, he prepares an affidavit for court documenting his findings, provides an explanation of how that diagnosis can interfere with the individual’s ability to participate in the legal proceedings and offers guidance on how the individual’s disability can be accommodated in court. He also documents how the individual’s symptoms and diagnosis may be related to their experiences in the country they are fleeing.

According to the Physicians for Human Rights Asylum Network, which encompasses more than 1,100 health professionals across the nation who provide evaluations for asylum cases, submitting this documentation with an application for asylum can make the difference between being granted safe haven in the United States and being deported.

“I think it’s very difficult to understand the lives of individuals who have had vastly different experiences than our own — what it means to be a woman in a rural area of Guatemala where her sons are being pressured to join gangs, what that experience is like, and why somebody would leave an area that’s ‘home’ to come somewhere else. It’s easy to think they’re here simply for economic reasons, but it’s something much more fundamental than that,” said Stovall.

“Each of these cases reminds me of the brutality in which people live for just doing things I think we all take for granted. Sometimes it’s just for being themselves — for being an ethnic minority, for speaking a dialect that’s not the dominant dialect or for taking part in the political process by supporting somebody who is not the popular choice. It’s basic issues of survival and dignity and the ability to lead one’s life.”

While most of his evaluations are conducted locally, recent changes in immigration laws have made it more likely for individuals to be held at the border as opposed to traveling freely between states throughout their legal proceedings.

In response to an increased need for evaluations in border states, Stovall traveled to the nation’s largest federal detention center in Dilley, Texas, in September to evaluate women who were being detained along with their children. Roughly 2,500 people were being held there, with large legal advocacy groups processing between 150-200 people daily to prepare them for their first round of hearings.

“Because individuals aren’t able to travel away from the border, the attorneys and psychiatrists have to come to them,” said Stovall.

Stovall offers senior psychiatry residents the opportunity to take part in local asylum evaluations as an elective to help them understand the role they can play in international communities. The experience can also help them better assist patients in their practice who may have a similar background.

“I think it’s helpful in a time where the issue can be politically charged for us as physicians to understand there’s the politics side of it, and then there’s the human, health care and legal system. There are institutions that, when they work well, can support a process that can help people,” said Stovall.

“Our role as physicians is to be part of that — either by participating or by advocating for the well-being of our patients and their families.”

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